Evaluating the effectiveness of a family empowerment program on family function and pulmonary function of children with asthma: A randomized control trial
Introduction
Childhood asthma is a highly prevalent chronic illness (Chang et al., 2013, Yeh et al., 2011) and affects many families’ lives (Svavarsdottir and Rayens, 2005). Complicated asthma management and recurrent asthma exacerbations could disturb family relationships and threaten daily family life (Santer et al., 2014), as well as cause parent–child discord for children with moderate asthma (Chiang, 2005). Parents suffer from high stress as they take on the responsibilities of self-managing asthma care for their children within the context of family life (Brown et al., 2010). Families with higher levels of family dysfunction and chronic family stress have shown that the children suffer from increased inflammatory production and asthma symptoms (Marin et al., 2009). Family function has also been shown to be a protector and benefit in coping with a childhood chronic illness (Rosland et al., 2010). However, previous interventions for improving the self-management for children with asthma were focused on asthma knowledge and disease management with educational and behavioural interventions (Clark et al., 2010, Guevara et al., 2003). The self-management plan predominantly emphasized a personal action asthma plan (Ring et al., 2007). Most self-management programs (Ahmad and Grimes, 2011, Welsh et al., 2011) emphasize only a caregiver's responsibility of monitoring adherence to treatment and not a comprehensive family care approach to address relieving parental stress or increasing family function (Horner, 1995).
For successful management, a case manager should consistently and patiently meet with the family to build a trusting relationship (Schulte et al., 2004). The major responsibility of paediatric nurses is providing holistic family-centred nursing care to improve family function (Kuhlthau et al., 2011) and to maintain a well-controlled asthma regimen for children to have normal growth and development. Until now, there has been no study implementing family empowerment methods and examining the effects on parental stress, family function, and the asthma conditions of children with asthma.
We developed the Asthma Family Empowerment Program (AFEP) based on Freire's empowerment theory to recruit the whole family with asthmatic children into the nursing intervention.
Section snippets
Family function and parental stress
Reviews of parental stress indicated that parental stress increases the risk of childhood wheezing among children with no parental history of asthma (Milam et al., 2008, Yamamoto and Nagano, 2015). Interactively, the family function and parent–child relationships, and management ability also influence the health of children with asthma (Preechawong et al., 2007). Two previous studies that have examined the effects of parental stress on the incidence of childhood asthma and wheezing, indicated
Aims
The aim of this study was to examine the effectiveness of the asthma family empowerment program (AFEP) for parents on parental stress, family function, and children's pulmonary function and asthma symptoms; in addition, we compared these families to families who only had self-management.
Study design
The study design was a randomized control trial to repeatedly measure the parental stress, family function, and children's pulmonary function and asthma symptoms. We measured three time points, including baseline and three-month and one-year follow-ups. A family empowerment program was implemented for 1.5 years and included four sessions over sixteen weeks.
Participants
Families with asthmatic children were recruited from a medical centre in middle Taiwan. Selection criteria included the following: (a) a
Demographic data of children and family
Table 2 showed the demographic data of children and their primary family caregivers in two groups. There were no significant differences between the groups in terms of gender, age, asthma severity, or marital status of family caregivers.
Parental stress and family function
Table 3 showed the average score of the Parental Stress Index (PSI) was significantly reduced from baseline (229.88) to three months (202.12), to one year (195.32) in the experimental group compared with the comparison group at baseline, and three months and
Discussion
The results of this study indicate that the Asthma Family Empowerment Program (AFEP) based on Freire's empowerment theory can reduce parental stress and improve family function (subscales of Cohesion, Expressiveness, Conflict, and Independent) from parents’ perceptions, as well as improve children's pulmonary function (FEV1, PEF) and reduce daily asthma symptoms compared with only asthma self-management interventions after one year of follow-up.
This study selected dysfunctional families whose
Conclusion
Childhood asthma is a condition that affects families, as they must manage a child with a complicated illness, which may lead to increased parental stress and impaired family function. The Asthma Family Empowerment Program (AFEP) is needed to develop and implement empowering strategies for families to care a child with chronic asthma. Resolving the impact of asthma on parental stress and enabling family function could improve children's pulmonary function and decrease their asthmatic
Implication for practice and policy
A child with a chronic illness affects the whole family. The asthma self-management intervention for children with asthma is a regularly provided service in current asthma clinics. Paediatric nurses can provide the intervention series to families and empower them by having them listen, dialogue, reflect on, and act out their problem solving ideas while making regular clinic visits. Continuing education and service training programs for paediatric nurses to improve their competency on empowering
Acknowledgements
This is supported by grants from the National Science Council (no. NSC97-2314-B-039-034-MY3). And the administrative support from the department of paediatric in China Medical University.
Conflict of interest. This is a follow-up evaluation study conducted by the researcher without conflict of interest.
Funding. This study is an experimental study that research nurse (first author) was a graduate student and was supported by the advisor Dr. Chiang for the cost from grant
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